Health Insurance Options For Immigrants – Nambi Ndugga Follow @nambinjn on Twitter, Drishti Pillai Follow @DrishPill on Twitter, and Samantha Artiga Follow @SArtiga2 on Twitter
June marks National Immigrant Heritage Month, which honors the contributions of immigrants to the U.S. In 2020, there are nearly 45 million immigrants living in the U.S., accounting for 14% of the total U.S. population. Immigrants are an important part of the nation’s workforce and families yet face barriers to accessing health coverage and care. While citizens account for the majority of the nonelderly uninsured population, noncitizens are more likely than citizens to be uninsured. Many legal immigrants and citizen children in immigrant families who are eligible for coverage remain uninsured due to a number of barriers, including immigration-related fears. Research shows that changes to immigration policy made by the Trump Administration are contributing to growing fears among immigrant families about enrolling in Medicaid and CHIP even if they are eligible. The Biden administration has since reversed some of these changes and implemented other policies to increase the enrollment of eligible people in public coverage options, but continued outreach efforts by delegates are believed to be key to reducing public fear.
Health Insurance Options For Immigrants
The pandemic seems to have exacerbated the health and financial challenges faced by immigrants, as they have increased risk for exposure and financial difficulties and face greater barriers to accessing tests, treatments, and vaccines, in part, due to immigration-related fears. In addition, migrants have faced new barriers to entry into the US, which have resulted in negative health impacts. Despite its role in the US, data is often missing to understand the diverse experiences of immigrants. Increasing data to understand their experiences is essential, given the growing population, the evolving immigration policy landscape, the impact of the pandemic, and the uptick in incidents of hate between racial groups. Steven A. Camarota is the director of research and Karen Zeigler is a demographer at the Center. Jason Richwine, PhD, is a public policy analyst based in Washington, D.C., and a contributing writer at National Review.
Immigrant Women’s Access To Sexual & Reproductive Coverage & Care
Many Democratic presidential candidates have made health insurance available to illegal immigrants. This analysis estimates the cost of providing illegal immigrants access to the existing system of government health benefits for low-income people. (We do not model the cost of scrapping the current system and giving all US citizens free government health insurance, as some candidates have proposed.) We estimate that there are 4.9 million uninsured illegal immigrants with low enough income to qualify for Medicaid or Advanced Premium. Tax Credit (APTC), which is a subsidy provided by the Affordable Care Act (ACA). Assuming a realistic enrollment rate, the cost of providing ACA subsidies to illegal immigrants will be about $10 billion per year, with costs rising to as much as $23 billion per year if all eligible illegal immigrants are enrolled. Costs would be similar in a hybrid approach that provides Medicaid for the lowest-income illegal immigrants and ACA subsidies for those with higher incomes.
Under current law, illegal immigrants are not allowed to participate in the healthcare exchanges established by the Affordable Care Act (ACA). As a result, they can’t get the Advanced Premium Tax Credit (APTC), which is a subsidy paid to insurance companies to help low-income people afford coverage. Illegal immigrants are also generally barred from participating in Medicaid, except for minors in some states and pregnant women nationwide. At the June 27 Democratic presidential debate, all candidates supported giving government health benefits to illegal immigrants, but there was no discussion of how it would be used or how much it would cost. According to a subsequent survey by The Atlantic, Bernie Sanders, Kamala Harris, Elizabeth Warren, Cory Booker, and Julian Castro will all “provide full benefits to the undocumented”. On the other side of the spectrum, Michael Bennet and Joe Biden proposed only allowing illegal immigrants to buy unsubsidized insurance in the health care exchange.1
In response to these proposals, the Center for Immigration Studies has released two new reports. The first report details the rate of participation and the cost of Medicaid use by immigrants in the existing policy, which offers noncitizens less access to the program compared to citizens.2 This second report explores the additional costs of offering public health benefits to illegal immigrants.3
Two common health benefits that are typically offered to low-income uninsured people are the ACA and Medicaid subsidies. There are nearly five million illegal immigrants in the country without health insurance with incomes low enough to qualify for these benefits. Since the average annual cost of this benefit is several thousand dollars per person, the total price tag for insuring illegal immigrants must be in the billions of dollars. Assuming 100 percent enrollment, we calculate the annual cost of providing ACA subsidies to be $22.6 billion, and $19.6 billion if illegal immigrants receive a mix of ACA and Medicaid credits. Assuming favorable enrollment rates, costs would be $10.4 billion for the ACA-only approach and $10.7 billion for a mix of ACA and Medicaid subsidies.
Immigrants And Private Insurance: Pay More, Use Less
People with incomes below 400 percent of poverty ($83,120 for a family of three in 2018) are eligible for ACA subsidies that reduce the amount they pay for health insurance. ACA subsidies are typically paid by the federal government to insurance companies on behalf of low-income consumers who purchase health insurance on federal or state-run exchanges. not offered insurance through their employer.5 The ACA was designed to provide Medicaid coverage to all adults with income below 138 percent of poverty ($28,676 in 2018 for a family of three). Empowered by a 2012 Supreme Court decision, many states chose not to expand Medicaid coverage, but ACA subsidies are still available to all low-income people (except illegal immigrants) in non-expansion states.6
The size of the ACA subsidy primarily reflects a person’s age and income, with income measured relative to the poverty threshold. The size of the subsidy increases as a person’s income decreases. People with the lowest incomes tend to be on Medicaid, especially in expansion states. Factors such as general health or pre-existing conditions do not affect the size of the premium or subsidy.
A detailed explanation of the method can be found at the end of this report. To summarize, we estimate the age and poverty status of illegal immigrants based on Census Bureau data and then calculate ACA subsidies for those whose incomes are low enough to qualify. For the lowest-income uninsured illegal immigrants, we also estimate the cost of providing Medicaid based on their state of residence, age, and disability status. Costs are calculated alternatively under the assumption of a 100 percent registration rate for all eligible illegal immigrants, and also under the assumption of a lower “likely” registration rate.
Figure 1 and Tables 1 and 2 summarize our findings. We estimate there are 4.9 million illegal immigrants who have incomes below 400 percent of the poverty threshold and who do not have insurance. This is the cutoff for premium subsidy. We run two scenarios: In Scenario 1, we estimate the cost if illegal immigrants receive ACA subsidies only. In Scenario 2, we examine the costs if the lowest-income illegal immigrants receive Medicaid, while the highest-income illegal immigrants receive ACA subsidies.
Biden Will Expand Health Care Access For Daca Immigrants
ACA Subsidy Only, 100 Percent Enrollment. Turning first to Scenario 1, we estimate that if all income-eligible uninsured illegal immigrants receive ACA subsidies, the total cost will be $22.6 billion in 2019. This total cost reflects the large number of uninsured illegal immigrants, coupled with the associated significant average cost. with subsidizing their premiums – $4,637, on average, shown in Table 2. While the overall cost will be large, the average ACA subsidy in 2019 for those who buy insurance on one of the exchanges is more than $7,000.7 The main reason illegal immigrants will receive a small average subsidy is that they are a relatively young population.
Possible Enrollment in ACA Subsidy Only. The above estimate is the cost of providing ACA credits to all 4.9 million low-income, uninsured illegal immigrants. However, as with any government program, not everyone who is eligible will enroll. For 2018, the Kaiser Family Foundation estimates that 46 percent of those with incomes low enough to qualify for subsidies actually purchased insurance through one of the health exchanges.8 We assume this is also true for illegal immigrants. If so, the total cost of providing ACA subsidies will be $10.4 billion annually, as shown in Figure 1 and Table 1. Although still large, this is less than half the cost of $22.6 billion if all income-eligible uninsured illegal immigrants are enrolled. 9
It is possible to use our analysis to generate an alternative estimate by multiplying the average ACA subsidy in Table 2 ($4,637) by the number of uninsured illegal immigrants one expects to actually use the program. For every one million uninsured illegal immigrants who sign up for ACA insurance and receive subsidies, the cost to taxpayers will be $4.6 billion per year.